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Biomedical subjects

L Seipel

Publications and source records attributed to L Seipel.

At least 145 records · Page 8Linked to original sources
PubMed1986

[Tricuspid valve insufficiency in patients with rheumatic mitral valve disease: angiographic diameter of the tricuspid ring and function of the right ventricle].

Dilatation of the right ventricle and a consecutive enlargement of the tricuspid valve ring are thought to be the main causes of functional tricuspid regurgitation in patients with rheumatic mitral valve disease. To study the effect of right ventricular dilatation as well as the dimension of the tricuspid valve ring, right ventricular volume indices, ejection fraction, regional shortening, pulmonary artery pressure, and the diameter and systolic shortening of the tricuspid valve were determined in 67 patients with rheumatic mitral valve disease (NYHA class II and III) from biplane ventriculographies. Patients with right ventricular enlargement (greater than 90 ml/m2) were divided into groups with (group IIA) and without (group IIB) tricuspid regurgitation and compared with patients with normal right ventricular size and function without tricuspid regurgitation (group I). There was no difference in the end-diastolic volume index, in the afterload or in the diameter of the tricuspid ring. Right ventricular ejection fraction was decreased in group IIA (51 +/- 9% vs. 59 +/- 10% (IIB) and 61 +/- 6% (control); (p less than 0.05). Regional function was also decreased in group IIA. 73% of the patients with tricuspid regurgitation had right ventricular enlargement, but only 44% of the patients with right ventricular enlargement had tricuspid regurgitation. Thus right ventricular dilatation promotes the development of a tricuspid insufficiency, but is not the only cause. Additional factors like decreased local wall motion, alterations of the valve or the valve apparatus may also account for functional tricuspid regurgitation.

Angiography↗
PubMed1986

[Doppler echocardiography diagnosis and classification of the degree of aortic valve insufficiency in patients with aortic stenoses and mitral valve diseases].

To test the capacity of pulsed Doppler echocardiography in the detection and quantification of aortic regurgitation, 64 consecutive patients with aortic and mitral valve disease were examined clinically and by echocardiography before cardiac catheterization. The severity of aortic regurgitation was determined angiographically (I-IV) and compared with the extent of the regurgitant jet in the left ventricle measured by pulsed Doppler echocardiography. In 15 of 64 patients neither angiography nor pulsed Doppler echocardiography showed aortic regurgitation (specificity 100%). Apart from 3 patients with poor echo quality pulsed Doppler echocardiography correctly detected aortic regurgitation in 46 of 49 patients (sensitivity 94%). Clinical examination (63%) and M-mode echocardiography (63%) were significantly less sensitive than Doppler echocardiography (p less than 0.001). The pulsed Doppler echocardiographic degree of aortic regurgitation correlated strongly with angiography (corrected contingency coefficient 0.91). In patients with severe aortic stenosis (systolic gradient greater than 50 mm Hg) aortic regurgitation I was slightly overestimated by pulsed Doppler echocardiography (p less than 0.003). Differentiation of aortic regurgitation III and IV was not possible. Mitral valve disease did not affect quantification of aortic regurgitation (n = 23).

Adolescent↗
PubMed1986

[2-dimensional echocardiographic analysis of the volume and function of the right ventricle in the apical and subcostal 4 chamber image].

To determine the diagnostic accuracy of two-dimensional echocardiography in the evaluation of RV dimensions and function, biplane angiography of the right ventricle and 2-D echo was performed in 60 consecutive patients and analyzed by two independent investigators. In 42 of 60 patients (group A) the RV could be visualized in the rotated apical 4 chamber view and in 18 patients in the subcostal 4 chamber view with good quality, which made it possible to define the right ventricular endocardium in the real-time proceeding. In 20 of these 42 patients the RV could be registered in the apical 4 chamber view with complete definition of the endocardium also in the stop frame (group B). Quantitative analysis was performed in the end-diastolic and end-systolic stop frame, using the area-length method. The correlation of echocardiography and angiography for the end-diastolic volumes was poor in group A (r = 0.62) and superior in group B (r = 0.73). The correlation coefficient for end-systolic volumes was r = 0.70 in group A and r = 0.92 in group B. End-diastolic and end-systolic volumes were systematically underestimated by echocardiography. RV ejection fraction did not correlate between both methods. The subcostal 4 chamber view was not sufficient in determining RV volumes and function. The results demonstrate that the right ventricle can be visualized in 70% of patients with sufficient quality. RV dimensions and volumes can be determined with high accuracy in these patients.

Cardiac Catheterization↗
PubMed1986

[Determination of the severity of tricuspid valve insufficiency using Doppler echocardiography].

In 187 patients with combined mitral and aortic valve lesions, to assess and quantify tricuspid regurgitation, biplane right ventriculograms were obtained and Doppler echocardiography performed for study of the tricuspid valve and right atrium. After definition of regurgitant turbulance across the tricuspid valve with pulsed Doppler, on mapping the right atrium the maximal length of regurgitant flow in the right ventricular inflow tract was determined from the short-axis parasternal view. In seven of 70 patients in whom angiographically tricuspid regurgitation was not detected, Doppler echocardiography demonstrated holosystolic insufficiency of the valve. In all patients with the angiographic diagnosis of tricuspid regurgitation grades I to III, this lesion was also documented Doppler echocardiographically with only slight divergence of the regurgitant area in the right atrium as viewed from the short-axis parasternal transducer position. In all patients, the tricuspid valve was morphologically unremarkable. In 32 patients, in agreement with angiographic findings, grade I tricuspid regurgitation was diagnosed; in seven patients the angiographic severity was overestimated by one grade. In 44 patients, in agreement with angiographic findings, tricuspid regurgitation grade II was detected; in four patients the Doppler echocardiographic severity was overestimated and five patients underestimated by one grade. In 23 patients with grade II tricuspid regurgitation angiographically, there was agreement with Doppler echocardiographic findings; in two patients the severity was underestimated by one grade.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1985

[Detection, quantification and localization of myocardial infarcts: comparison of thallium single photon emission computer tomography with biplane angiography].

Thallium-201 single photon emission computed tomography (SPECT) is a new method for the scintigraphic visualization of the left ventricular myocardium. With SPECT a three-dimensional imaging by computerized slicing of the myocardium in various axes is possible. To investigate the capabilities of this new imaging technique, detection and quantification of remote transmural infarctions were compared with ventriculographic, coronarographic and electrocardiographic findings. 31 of 80 investigated patients had had a prior myocardial infarction. The left ventricular myocardium was divided into 7 regions in the scintigraphic as well as in the angiographic studies. In a total of 560 segments the sensitivity of SPECT for infarct detection was 87.5% with a specificity of 99.8%. Infarcts which were not detected scintigraphically were relatively small (mean 13.5% of the circumference). To quantify the infarct, the size of the defect was determined scintigraphically from a sagittal long axis and two short axes, and the images compared with angiographic infarct sizes (% of the circumference) according to the method of Feild et al. A good correlation without overestimation of the size by one method (SPECT defect = 0.93 X ventriculographic defect - 1.2%; r = 0.7, p less than 0.001) was obtained. Also a good separation of the perfusion areas of the coronary arteries due to the three-dimensional imaging with SPECT was possible. Thus, by employing Thallium-201 SPECT of the left ventricular myocardium exact localization and quantification of transmural myocardial infarcts with a positive predictive value of 98% can be achieved.

Coronary Disease↗
PubMed1985

[Frequency, localization and extent of local wall function disorders of the left ventricle in patients with rheumatic mitral valve diseases].

In 59 patients with rheumatic mitral valve disease, local wall motion was assessed by analysing the diastolic and systolic left ventricular silhouette from biplane angiograms with a quantitative radial axes model using 90 radii in each projection. The left ventricle was dissected into 4 segments in the RAO and 2 segments in the LAO projection and a mean radii shortening for each segment was calculated. 27 patients had pure severe mitral stenosis (MS), 10 patients mitral insufficiency (MI) and 22 patients combined mitral valve disease (MSMI). A mean radii shortening less than 25% was diagnosed as wall motion abnormality. In 78% of all patients wall motion abnormalities could be detected in at least one segment. 32% of patients with MS, 27% of patients with MI and 33% of patients with MSMI had wall motion abnormality of the anteroapical wall. In only 8% of patients with MS and in no patients with MI and MSMI was the posterobasal segment disturbed. The anterobasal and diaphragmal wall motion showed wall motion abnormality in 16% and the septal and the posterolateral area in 17% of all patients. 78% of all patients had at least one diseased segment; motion abnormalities of the anteroapical wall (seg. 2) occurred most often whereas the posterobasal area (seg. 4) was diseased in only 4% of all patients. Ejection fraction was severely impaired (less than 55%) in 7 patients only (5 of these patients had MS) with wall motion abnormalities in more than 4 segments. There was no correlation between the extent of valve disease and occurrence and extent of wall motion abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Clinical value of 2-dimensional echocardiography for quantifying mitral stenosis--possibilities and limits of the method].

In 70 consecutive patients with the clinical diagnosis of mitral valve disease quantification of the mitral valve area was performed by 2-D echocardiography. In only 39 of these 70 patients (58%) could the mitral valve be satisfactorily positioned in the short-axis view for correct quantification of the valve area. In 31 patients a sufficient echo could not be assessed because of anatomical disorders, calcification of the valve or postoperative deformities of the valve apparatus after commissurotomy. In 30 of the 39 patients, in whom 2-D echocardiography allowed to determine the valve area, the results of the echocardiographic study corresponded with the valve area determined by angiography using the modified Gorlin formula. A sufficient correlation between both methods, however, was found only in patients with combined mitral valve disease (r = 0.81); no correlation could be found in the group of patients with pure mitral stenosis. From these results we conclude that in the individual patient 2-D echocardiography is not sufficient for exact quantification of mitral stenosis. Definite preoperative diagnosis necessitates additional investigations.

Adult↗
PubMed1985

[Unusual rhythm disorders with a DDD pacemaker].

A tachycardia caused by an inadvertent change of the lead connections in a patient with a DDD pacemaker is reported. This was demonstrated by operating in different modes (i.e. AOO, VOO) by displaying the marker channel graphically and by X-ray examination revealing unchanged lead positions.

Electrocardiography↗
PubMed1985

[Changes in diastolic ventricular properties by intravenous nifedipine infusion in patients with unstable angina pectoris].

In 16 patients with unstable angina pectoris 2 mg of nifedipine were infused intravenously for 1 hour. From coronary angiograms and cineventriculograms before and after nifedipine infusion vessel and stenosis diameters and global and regional left ventricular function were determined. Pressures in the left ventricle (Millar catheter tip manometer), aorta and pulmonary artery were measured continuously. Intravenous nifedipine infusion decreased left ventricular systolic pressure from 131.9 +/- 15.3 to 119.1 +/- 18.6 mm Hg (p less than 0.001) and mean aortic pressure from 94.4 +/- 13.6 to 85.8 +/- 15.0 mm Hg (p less than 0.01) and increased heart rate from 70.6 +/- 10.6 to 77.5 +/- 10.4, with no change in pressure rate product. Left ventricular volumes declined significantly (EDVI from 94.4 +/- 16.7 to 79.4 +/- 17.1 ml/m2 p less than 0.001, ESVI from 34.2 +/- 9.3 to 27.2 +/- 10.4 ml/m2 p less than 0.001). Ejection fraction increased slightly from 63.2 +/- 7.8 to 66.2 +/- 9.4% (p less than 0.05). Regional wall motion did not change, either in ischemic or in normally perfused areas. A change in coronary vessel or stenosis diameter was not observed. There was a remarkable 46% decrease in left ventricular enddiastolic pressure (from 11.1 +/- 5.1 to 6.0 +/- 2.3 mmHg, p less than 0.001) which developed slowly and not parallel in time to the afterload reduction. The cause appears to be the normalization of an increased left ventricular compliance documented by a significant decrease of the late diastolic dp/dV from 0.35 +/- 0.22 to 0.07 +/- 0.02 mm Hg (p less than 0.001) after nifedipine infusion. This implicates a direct myocardial effect of calcium antagonists on the ischemic myocardium.

Angina Pectoris↗
PubMed1984

Effect of propafenone in the Wolff-Parkinson-White syndrome: electrophysiologic findings and long-term follow-up.

The electrophysiologic and long-term efficacy of propafenone, a relatively new antiarrhythmic agent, was assessed in 47 patients with accessory pathways. In 23 patients (group I), the electrophysiologic effects were assessed initially. In 19 patients in this group and in 24 additional patients (group II), long-term therapy with oral propafenone was initiated. The mean age of the patients was 38 years in group I and 41 years in group II. The duration of a history of tachycardia in both groups was 12 years (mean); 14 patients previously had had attacks of syncope. During the electrophysiologic study in group I, propafenone did not change the spontaneous sinus rate. Corrected sinus node recovery time as well as the AH interval, HV time, QRS duration and effective refractory periods of the atria and ventricles was significantly prolonged. The effective refractory period of the accessory pathway increased from 238 to 322 ms (p less than 0.02). The 1:1 conduction capacity of the accessory pathway decreased from 231 to 176 beats/min (mean; p less than 0.01). Complete block in the anterograde direction occurred in 6 patients. The shortest RR interval during atrial fibrillation increased from 232 to 303 ms (p less than 0.05). The retrograde refractory period of the accessory pathway was prolonged from 245 to 295 ms (p less than 0.01). Complete or 2:1 retrograde block during basic drive occurred in 3 patients and 1 patient, respectively. In 6 of 15 patients, propafenone made sustained supraventricular tachycardia (SVT) either no longer inducible or nonsustained. The cycle length of induced SVT increased from 324 to 395 ms (p less than 0.01). During long-term administration (follow-up duration 2 to 3 years), 17 of 43 patients did not report any episode of symptomatic tachycardia. In another 18 patients, tachycardia was rare, slower and self-terminating. In only 3 patients, the frequency and severity of attacks had not changed. One patient with dilated cardiomyopathy died suddenly. Side effects necessitating discontinuation of medication were observed in only 2 patients. The remaining side effects, if present, were tolerated, and dosage dependent. In conclusion, propafenone is an effective and well-tolerated antiarrhythmic agent in the long-term management of patients with the Wolff-Parkinson-White syndrome.

Adolescent↗
PubMed1984

[Cholestasis after antiarrhythmic therapy with propafenone].

Propafenone, three times 150 mg/d over 33 days and two years later at the same dosage over six days, was administered to an 84-year-old man with ventricular extrasystoles (Lown IVa). Both times intrahepatic biliary stasis occurred, presumably a sign of a drug-allergic hepatitis. All other possible causes in the differential diagnosis were excluded. The lymphocyte transformation test demonstrated in vitro propafenone-sensitive patient-lymphocytes.

Aged↗
PubMed1984

Prevalence and clinical significance of the repetitive ventricular response during sinus rhythm in coronary disease patients.

The prevalence of the repetitive ventricular response (RVR) after single and double premature stimulation during sinus rhythm or a paced supraventricular rhythm at a rate of 85 bpm was assessed in 343 patients (group 1: 237 patients studied prospectively who were referred for coronary arteriography and ventriculography; group 2: 44 patients after recent acute myocardial infarction; group 3: 61 patients with documented ventricular tachycardia and/or fibrillation). In group 1 patients, RVR testing was performed from both the right ventricular apex (n = 237) and outflow tract (n = 190), whereas in the remaining patients only the apex was stimulated. In group 1, RVR after a single premature stimulus occurred in 21.9% and after two stimuli in 63.2%. In patients with normal left ventricular (LV) function (n = 63) the prevalence of RVR after a single stimulus was significantly less (9.5%) than in those with LV dysfunction (n = 174;26.4%,p less than 0.01). However, after double stimulation, there was no longer any difference. In group 2, the prevalence of RVR was 25% after one and 34.1% after two premature stimuli. In group 3 patients, RVR was observed in only 14.8% after one and in 41% of patients after two premature stimuli. Ventricular tachycardia (greater than or equal to 10 QRS) was induced in nine patients during a supraventricular rhythm. Two hundred thirty-seven patients of group 1, who were prospectively studied in order to assess the prognostic significance of the RVR, were followed for a mean period of 27.2 +/- 10.7 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗